Frustrated with dentist fees

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Grt2bOutdoors
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Re: Frustrated with dentist fees

Post by Grt2bOutdoors » Tue Oct 15, 2019 8:23 am

My experience has been, the service is covered subject to a deductible and a maximum co-insurance charge of X% paid by the patient.
This frustration on your part sound like you were subjected to the deductible and co-insurance charge. Dental insurance, well, it can be a how shall we say it "a racket"? If you don't use the services, you've paid money away that you could be saving. On the other hand, if you do use the services on a frequent basis, you could be saving more than you are paying away. The thing is, even if you floss, brush your teeth and watch what you eat, it is zero assurance that you won't need the services of a dentist in the future.
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RickBoglehead
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Re: Frustrated with dentist fees

Post by RickBoglehead » Tue Oct 15, 2019 8:26 am

Our dentist's office has a good handle on coverage, and informs us.

We had an issue when we changed insurance companies. I called and had it changed in the records when we made the checkup appointments, but the office manager didn't make the change she said she would. As a result, they gave us fluoride treatments that were not covered. She called about a week later, asked what our insurance was, and I told her it was exactly what we had discussed when I made the appointment. She said ok, hung up, and I never heard back, but they ate the cost.
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knightrider
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Re: Frustrated with dentist fees

Post by knightrider » Tue Oct 15, 2019 9:04 am

In short, medical insurance is more complicated than medicine! Folks who say patients needs to read all the rules of what they sign up for are being unrealistic.. No average joe can be expected to fully understand how complex insurance is. The explanation of benefits is another joke designed to further confuse and obfuscate things. One needs an explanation of the explanation of benefits!

Same thing happens in everything in life.. Finance and tech are merging to make the simplest of tasks incredibly complex.
Last edited by knightrider on Tue Oct 15, 2019 9:48 am, edited 1 time in total.

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dm200
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Re: Frustrated with dentist fees

Post by dm200 » Tue Oct 15, 2019 9:43 am

knightrider wrote:
Tue Oct 15, 2019 9:04 am
In short, medical insurance is more complicated than medicine! Folks who say, patients needs to read all the rules of what they sign up for are being unrealistic.. No average joe can be expected to fully understand how complex insurance is. The explanation of benefits is another joke designed to further confuse and obfuscate things. One needs an explanation of the explanation of benefits!
Same thing happens in everything in life.. Finance and tech are merging to make the simplest of tasks incredibly complex.
I try to read and understand health/medical/dental insurance - and have been moderately successful - over the years. I do agree that this is a huge challenge for everyone - especially the 'average joe'

Right now - with my Kaiser Medicare and Kaiser additional dental coverage - I think I do fairly well - both in understanding coverage - as well as balancing costs and benefits when choosing options each year. Much of my understanding Medicare is thanks to folks here ;)

One common, in my opinion, mistake I see from friends and acquaintances on Medicare is their belief that they are better off (BOTH financially and medically) by choosing the higher premium choices. In my opinion, they are often "wasting" a lot of money by choosing the higher premium choices. Another situation I see with such friends and acquaintances is not knowing when they are overcharged - and how to get this corrected. In our Kaiser Medicare plan, for example, billing/charging errors are uncommon - but they do happen. DW and I stay on top of this and about once every 2-3 years (on average) we note some kind of such error and get it corrected quickly.

Unfortunately, I do not see any of this "complexity" and "confusion" getting better any time soon. I believe DW and I will be fine unless and until we begin to show "cognitive decline".

I do believe, though, that keeping up on this complexity actually helps keep our cognitive ability from declining - at least for a while ;)

HomeStretch
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Re: Frustrated with dentist fees

Post by HomeStretch » Tue Oct 15, 2019 10:10 am

knightrider wrote:
Tue Oct 15, 2019 9:04 am
In short, medical insurance is more complicated than medicine! Folks who say patients needs to read all the rules of what they sign up for are being unrealistic.. No average joe can be expected to fully understand how complex insurance is. The explanation of benefits is another joke designed to further confuse and obfuscate things. One needs an explanation of the explanation of benefits!
Agree that healthcare insurance can be complicated. I don’t expect participants to read all the coverage rules. But, having had HR and Finance report into me, I can say it can be astounding to see the number of employees covered by employer benefit plans like healthcare insurance that do not try to understand the basics about their benefits (like not even reading enrollment materials).

The dental coverage items discussed by some here like understanding whether dentists are in/out of network, requesting a predetermination of benefits and being aware of deductible/co-insurance requirements are all “basics” in my book.

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dm200
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Re: Frustrated with dentist fees

Post by dm200 » Tue Oct 15, 2019 10:15 am

HomeStretch wrote:
Tue Oct 15, 2019 10:10 am
knightrider wrote:
Tue Oct 15, 2019 9:04 am
In short, medical insurance is more complicated than medicine! Folks who say patients needs to read all the rules of what they sign up for are being unrealistic.. No average joe can be expected to fully understand how complex insurance is. The explanation of benefits is another joke designed to further confuse and obfuscate things. One needs an explanation of the explanation of benefits!
Agree that healthcare insurance can be complicated. I don’t expect participants to read all the coverage rules. But, having had HR and Finance report into me, I can say it can be astounding to see the number of employees covered by employer benefit plans like healthcare insurance that do not try to understand the basics about their benefits (like not even reading enrollment materials).
The dental coverage items discussed by some here like understanding whether dentists are in/out of network, requesting a predetermination of benefits and being aware of deductible/co-insurance requirements are all “basics” in my book.
Yes - "basics" indeed!

dbr
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Re: Frustrated with dentist fees

Post by dbr » Tue Oct 15, 2019 10:21 am

If $150 is the amount of concern, then you have not even begun to see what dental costs can amount to, with insurance ans no funny business going on either. Dental costs are an expense that needs to be budgeted realistically.

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dm200
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Re: Frustrated with dentist fees

Post by dm200 » Tue Oct 15, 2019 10:25 am

When selecting a dentist, it seems to make sense to try to determine how well the prospective dentist handles insurance, as well as how well he/she bills for various procedures. And - from a previous post - how well it is to deal with the office staff.

DW and I have always dealt with dentists in individual practice. Any pros and cons of dealing with a dentist in a group practice?

knightrider
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Re: Frustrated with dentist fees

Post by knightrider » Tue Oct 15, 2019 10:27 am

HomeStretch wrote:
Tue Oct 15, 2019 10:10 am
The dental coverage items discussed by some here like understanding whether dentists are in/out of network, requesting a predetermination of benefits and being aware of deductible/co-insurance requirements are all “basics” in my book.
Basics for boglehead members, but not for average joes, in my opinion. There was a study that said if everyone actually read all the legalese/toc/fine print you are presented with it would take 67 years.

So average joes ignore it for the same reason they ignore everything else overly technical.. You and I know it's important, but they don't because they can't differentiate it from other complex stuff. So simpler just to tune it all out..

elainet7
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Re: Frustrated with dentist fees

Post by elainet7 » Tue Oct 15, 2019 11:06 am

most plans have copays and deductibles
some procedures like a BUILD UP for a crown might not be covered
Insurance does not cover 100% of care and pts do not want to pay

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Jimsad
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Re: Frustrated with dentist fees

Post by Jimsad » Tue Oct 15, 2019 12:21 pm

AlohaJoe wrote:
Mon Oct 14, 2019 8:00 pm
HueyLD wrote:
Mon Oct 14, 2019 4:16 pm
I think the main problem you encountered was the rude office personnel. If you like the dentist, please let him know that his employee did a dis-service to the patients.
samsoes wrote:
Mon Oct 14, 2019 3:56 pm
That rude staff member who threatened collection action would cause me to find a new dentist post-haste, while leaving behind an online review regarding the office staff.
It is hard to know whether the staff member was actually rude when we only hear one side of the argument. The OP started a nearly identical thread in January about dental insurance.
The staff was definitely rude and I am frustrated because they necessary gave me an EOB and never told me upfront ghis May happen

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FlyAF
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Re: Frustrated with dentist fees

Post by FlyAF » Tue Oct 15, 2019 1:45 pm

You've literally started the exact same thread before on this website, the only thing different being the dollar amounts. Did you read the responses in your original thread? Did you read your dental insurance policy documents after the last "incident" and this new one?

If I was the dentist, I'd clear your tab, cut bait, and suggest a drive through dentist in a strip mall.

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BarbaricYawp
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Re: Frustrated with dentist fees

Post by BarbaricYawp » Tue Oct 15, 2019 2:19 pm

Things continue to change in all kinds of medical coverage, and not for the better. If you don't know whether a particular procedure is covered, *ask*. I have trained DH and kids to ask whether our insurance covers the proffered process and if not, to get an estimate so we can discuss and perhaps schedule it later. Unless you have some kind of true emergency most of these things can be done either on a separate visit or the next one. Sad to say but generally the only urgency is maximizing revenue on that visit for that dentist. Remember, they only have so many hours in the day so the more services they can sell you on a single visit, the more revenue.

Regarding office staff rudeness: yes, entirely possible. My family and I have been using the same dentist for over 20 years through multiple insurance companies. 6 mouths worth of dental care. Braces, bridges, cleanings, extractions, you name it. I've been going to this practice so long I have outlasted most of the office staff and several of the technicians. Mid year our company insurance policy number changed (I have no idea why -- it was the same company and the same level of coverage, employees didn't have to do anything. It just was announced by HR via email). On my next visit I was told that by the dental office staff that even though nothing but the number had changed I would need to PRE-PAY for services and get reimbursed from my insurance company because they didn't have the new insurance information until I walked in for the appointment and therefore they didn't have me pre-qualified under the 'new' number. This despite already signing reams on paper on behalf of self and kids as to the assumption of the payment if the insurance company didn't pay the fees for whatever reason. I told the office staff that I had been a long-term patient, had always paid an overages promptly and I would -- reluctantly -- find a new dentist if I was going to be treated like a new patient with no personal payment history after 2+ decades. I was then informed that if they had to send me a bill there would be a FEE for billing me (!). After a restrained but truly snarky exchange we agreed that they would somehow manage to struggle along without my modest cleaning fee for the 24 hours that it would take them to run it through 'new' insurance and that I would, as always, pay any overages promptly. Without a billing fee.

I get it that dentists are small business owners, and that collections are a pain. But this dentist isn't a low cost provider and there is almost always a balance owed. Generally I pay it on my way out. A glance at their system would have shown my payment history but instead they chose to attempt to strongarm me over something that was truly fluky (new policy number) and probably verifiable with a phone call while I was in the chair. I'm still using this practice, but will probably never be as confident in them as I had been. And yes, although there was no swearing ('Southern rude" relies on intonation and body language) the office insurance specialist was most definitely rude.
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HomeStretch
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Re: Frustrated with dentist fees

Post by HomeStretch » Tue Oct 15, 2019 2:27 pm

BarbaricYawp wrote:
Tue Oct 15, 2019 2:19 pm
And yes, although there was no swearing ('Southern rude" relies on intonation and body language) the office insurance specialist was most definitely rude.
Hopefully the words “bless your heart” were not uttered!

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JoeRetire
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Re: Frustrated with dentist fees

Post by JoeRetire » Tue Oct 15, 2019 2:33 pm

Jimsad wrote:
Tue Oct 15, 2019 12:21 pm
The staff was definitely rude and I am frustrated because they necessary gave me an EOB and never told me upfront ghis May happen
EOBs come from your insurer, not from dental staff.
Very Stable Genius

deltaneutral83
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Re: Frustrated with dentist fees

Post by deltaneutral83 » Tue Oct 15, 2019 2:46 pm

90 second solution: Call Dentist, speak to office manager, tell them to review your insurance and to make a note in your file that you do NOT want any services not covered by insurance (i.e. you do not want anything other than the cleaning and the X rays). Ask to speak directly to the dentist and explain it again if you perceive the office manager isn't competent. When you walk in for appointment at a later date, reiterate to the front desk and the hygienist that sees you that you just need services for what your insurance provides. This is a cheap lesson ($150) in the world of healthcare for not doing your homework.

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BarbaricYawp
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Re: Frustrated with dentist fees

Post by BarbaricYawp » Tue Oct 15, 2019 2:50 pm

HomeStretch wrote:
Tue Oct 15, 2019 2:27 pm
BarbaricYawp wrote:
Tue Oct 15, 2019 2:19 pm
And yes, although there was no swearing ('Southern rude" relies on intonation and body language) the office insurance specialist was most definitely rude.
Hopefully the words “bless your heart” were not uttered!
Luckily, no! That phrase usually precedes a slapfest in this part of the world lol
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MichCPA
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Re: Frustrated with dentist fees

Post by MichCPA » Tue Oct 15, 2019 3:02 pm

dm200 wrote:
Mon Oct 14, 2019 4:39 pm
Starfish wrote:
Mon Oct 14, 2019 4:35 pm
It's hard (maybe impossible?) to know in advance what insurance will cover.
Do you want the dentist to take the best action for your health or the action insurance wants him too? Because I can tell you that insurance does not care a bit about you, they care about the minimum payment and their bottom line.
People don't understand that dental insurance is against their interest (health) and it pushes dentists into performing bad procedures.
Just as with almost any kind of Physician or Dentist, I suspect that such providers cannot be expected to know the details of every patient's insurance coverage. With Physicians, it seems to me that if, say, a Physician saw 25 patients in one day - each of the 25 might have, at least, some differences in their insurance coverage.
^^This, unless you ask for an estimate for a procedure there is no way to figure out the cost. My company has two different levels of coverage with the same network and I wouldn't expect the dentist office to know the rules for my plan top of mind. I also don't think OP understands that most dental insurance covers a % of cost rather than just forking over a co-pay. That is before we get to cost caps. There is a stark difference in price transparency between a PPO health plan and the average dental plan.

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Jimsad
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Re: Frustrated with dentist fees

Post by Jimsad » Tue Oct 15, 2019 3:15 pm

FlyAF wrote:
Tue Oct 15, 2019 1:45 pm
You've literally started the exact same thread before on this website, the only thing different being the dollar amounts. Did you read the responses in your original thread? Did you read your dental insurance policy documents after the last "incident" and this new one?

If I was the dentist, I'd clear your tab, cut bait, and suggest a drive through dentist in a strip mall.
And I guess you will also tell your staff to be rude and disrespectful to all your patients

MichCPA
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Re: Frustrated with dentist fees

Post by MichCPA » Tue Oct 15, 2019 3:21 pm

Jimsad wrote:
Tue Oct 15, 2019 3:15 pm
FlyAF wrote:
Tue Oct 15, 2019 1:45 pm
You've literally started the exact same thread before on this website, the only thing different being the dollar amounts. Did you read the responses in your original thread? Did you read your dental insurance policy documents after the last "incident" and this new one?

If I was the dentist, I'd clear your tab, cut bait, and suggest a drive through dentist in a strip mall.
And I guess you will also tell your staff to be rude and disrespectful to all your patients
To be fair, the sarcastic tone of responses isn't exactly endearing.

voodoo72
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Re: Frustrated with dentist fees

Post by voodoo72 » Tue Oct 15, 2019 4:25 pm

JoeRetire wrote:
Tue Oct 15, 2019 2:33 pm
Jimsad wrote:
Tue Oct 15, 2019 12:21 pm
The staff was definitely rude and I am frustrated because they necessary gave me an EOB and never told me upfront ghis May happen
EOBs come from your insurer, not from dental staff.
Yep it that simple, read your EOB it will say " patient responsibility" for how much you owe. United Concordia is the worst , most definitely not a good insurance, and just because they denied a dental procedure doesn not mean you didnt need it. They are very happy when they dont pay for things and you get upset at the doctor and not them. Remember you and your employer pay every pay period for this insurance, so your issue may be with them as well.

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scubadiver
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Re: Frustrated with dentist fees

Post by scubadiver » Tue Oct 15, 2019 4:47 pm

dratkinson wrote:
Mon Oct 14, 2019 8:29 pm
If OP does not like his dental insurance, he has the option to buy better insurance or opt-out. Works for me.
It has been my experience that what is often referred to as dental insurance is really more like a service plan covering a certain number of cleanings and dental x-rays per year. Basically, it's a cash transfer from you through your employer and your insurance company to your dentist. If your employer is fully or partially subsidizing that for you or you can get a tax benefit through payroll deductions, great. Otherwise, it may be worth it to shop around, find a dentist you like who will take cash and just "self-insure".

I would work hard however to establish trust with your dentist. Like many things in life, this is a relationship that you have to manage. If you don't trust the advice they are giving, that relationship is going to be difficult to manage.

Good luck,
Scubadiver

supersharpie
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Re: Frustrated with dentist fees

Post by supersharpie » Tue Oct 15, 2019 5:12 pm

Jimsad wrote:
Tue Oct 15, 2019 3:15 pm
FlyAF wrote:
Tue Oct 15, 2019 1:45 pm
You've literally started the exact same thread before on this website, the only thing different being the dollar amounts. Did you read the responses in your original thread? Did you read your dental insurance policy documents after the last "incident" and this new one?

If I was the dentist, I'd clear your tab, cut bait, and suggest a drive through dentist in a strip mall.
And I guess you will also tell your staff to be rude and disrespectful to all your patients
1. There are two sides to this story and we are only hearing yours. You may have acted like a huge PITA to the staff for all we know.

2. Whether you like it or not, it is not illegal for the dentist to charge you for services rendered, not covered by insurance. Labor was performed and compensation is due.

4. It’s $150, not $15,000. Pay the bill, look at this as an inexpensive lesson learned, and move on to a new dentist.

SrGrumpy
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Re: Frustrated with dentist fees

Post by SrGrumpy » Tue Oct 15, 2019 5:59 pm

dbr wrote:
Tue Oct 15, 2019 10:21 am
If $150 is the amount of concern, then you have not even begun to see what dental costs can amount to, with insurance and no funny business going on either. Dental costs are an expense that needs to be budgeted realistically.
Ha! I can't remember the last time my dental bill was only $150.

mayday23
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Re: Frustrated with dentist fees

Post by mayday23 » Tue Oct 15, 2019 8:18 pm

I used to work for a dental insurance company. This is how it works:

Dentists are in or out of network.

In Network:
They contract with the insurance (ie blue cross) to provide services at a specified cost. Ie – Dental Cleaning is $75 and that’s it
They join the network so they get more customers/patients. They will show up when you search for a dentist on the insurance webpage
They generally receive less money for the services they provide
They submit the claims to the insurance company
Your company plan dictates how much you pay out of pocket (ie a percentage or flat fee for cleaning). You can have “top tier” insurance coverage such as Blue Cross, but your company dictates their risk and what they cover vs forcing the employee to pay.

Out of network:
No contract with the insurance company. In the example above, they can charge $100 for a cleaning. They would receive $75 from insurance and you would owe the $25 difference.
They will generally submit the insurance on your behalf, but some don’t deal with it so the customer/patient needs to submit it. If patient submits, then patient pays $100 out of pocket to dentist, then gets the $75 check from insurance. Patient still “out” the $25

Either in/out of network can submit a pre-claim that is the procedure codes and the insurance company will tell you what they cover. The patient/customer should always have this done so they know what it coming out of their pocket. In extreme emergencies, this isn’t feasible.

HornedToad
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Re: Frustrated with dentist fees

Post by HornedToad » Tue Oct 15, 2019 8:35 pm

Jimsad wrote:
Tue Oct 15, 2019 3:15 pm
FlyAF wrote:
Tue Oct 15, 2019 1:45 pm
You've literally started the exact same thread before on this website, the only thing different being the dollar amounts. Did you read the responses in your original thread? Did you read your dental insurance policy documents after the last "incident" and this new one?

If I was the dentist, I'd clear your tab, cut bait, and suggest a drive through dentist in a strip mall.
And I guess you will also tell your staff to be rude and disrespectful to all your patients
Your approach in this thread has been that “why doesn’t the dentist just take what my insurance gives and be happy.” If you took the same argument with the dental office I could see why they could get upset since you are not acknowledging you owe anything for service and they should take whatever is given and it’s their fault your insurance denied it.

Work with your insurance company to see why it was denied before doing anything else

mariezzz
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Re: Frustrated with dentist fees

Post by mariezzz » Wed Oct 16, 2019 3:47 pm

TexasPE wrote:
Mon Oct 14, 2019 8:50 pm
dratkinson wrote:
Mon Oct 14, 2019 8:29 pm
I've self-insured for 20yrs. Most recently:
--New patient exam, x-rays, and cleaning: ~$400. (Old dentist closed office.)
--Root canal and temporary crown: ~$1100. (My last root canal was >20yrs ago.)
--New crown: ~$1400. (My last crown was >20yrs ago.)
--Regular cleaning: ~$150.
Interesting - I am also self insured
x-rays and cleaning $124
cleaning only $74
temp and new crown (no root canal) $650
The cost of the crown can vary widely - in part, it depends on what the crown is made of. There are some newer options (zirconia, lithium disilicate (emax) and others) for crowns that have come out in the last 10 years, which in many situations provide better, longer-lasting crowns than porcelain-fused-to-metal crowns. And of course, these newer options usually cost more. It can be confusing because, for example, there are multiple options under the 'zirconia' umbrella. The newer materials at times can help preserve tooth structure better (less needs to be removed to prepare the tooth for the crown) and may last longer (on average).

Without dental insurance, I wouldn't expect a high quality crown made of newer materials (or even porcelain fused to metal) for $650 from a private dentist. You might get that price from a dental school. The cost of living in an area also likely influences what the dentist charges - they have to pay themselves and their staff. A long-established independent dentist in a low cost of living area might be able to charge less.

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TexasPE
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Re: Frustrated with dentist fees

Post by TexasPE » Wed Oct 16, 2019 4:24 pm

mariezzz wrote:
Wed Oct 16, 2019 3:47 pm
TexasPE wrote:
Mon Oct 14, 2019 8:50 pm
dratkinson wrote:
Mon Oct 14, 2019 8:29 pm
I've self-insured for 20yrs. Most recently:
--New patient exam, x-rays, and cleaning: ~$400. (Old dentist closed office.)
--Root canal and temporary crown: ~$1100. (My last root canal was >20yrs ago.)
--New crown: ~$1400. (My last crown was >20yrs ago.)
--Regular cleaning: ~$150.
Interesting - I am also self insured
x-rays and cleaning $124
cleaning only $74
temp and new crown (no root canal) $650
. A long-established independent dentist (YES) in a low cost of living area (YES) might be able to charge less.

The crown I referenced WAS Zirconia for $650. My long-time (20+ years) dentist retired and recommended my current dentist (age - late 50s) when I found the young dentist who purchased his practice 'discovered' lots of cosmetic options I needed that the original dentist never recommended. Guess the young dentist has some serious student loans to cover... :moneybag
At 20: I cared what everyone thought about me | At 40: I didn't give a damn what anyone thought of me | Now that I'm 60: I realize that no one was really thinking about me at all | Winston Churchill (?)

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Jimsad
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Re: Frustrated with dentist fees

Post by Jimsad » Wed Oct 16, 2019 4:41 pm

Update-
The office manager called and apologized and told me they are appealing the insurance denial and insurance may still pay as they are providing them more info and I can hold off on paying anything till they hear back from insurance .
She did make me aware that the initial paperwork I signed indicated I am responsible for payment if Insurance denies payment even though they are in network with my insurance ( I did not pay attention to this detail when I did the initial paperwork ).
This is definitely a different set of rules compared to other medical providers I see who cannot bill patient for denied insurance payments as they are ‘ contracted with insurance as in net work providers’
Also the service in question was a ‘covered service ‘ but Insurance May still not pay it . Have to wait and see .

toofache32
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Re: Frustrated with dentist fees

Post by toofache32 » Wed Oct 16, 2019 5:00 pm

Jimsad wrote:
Wed Oct 16, 2019 4:41 pm

This is definitely a different set of rules compared to other medical providers I see who cannot bill patient for denied insurance payments as they are ‘ contracted with insurance as in net work providers’
Why can't they bill you? Who should pay for services in this scenario?

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Jimsad
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Re: Frustrated with dentist fees

Post by Jimsad » Wed Oct 16, 2019 5:16 pm

It is just that other medical specialists , when they contract with insurance as ‘in network ‘ they benefit by getting more patients from that insurance company as they are ‘in Network’
In return , they agree to take the loss if insurance does not pay for a service .
Before everybody jumps all over me , I did not make up the above rules - I am just stating what I have seen from personal experience as I saw EOBS from insurance where they specifically say the provider cannot bill patient for denied services as they are in network (non dental medical doctors )
However , I now acknowledge that dental insurance seems to have different set of rules

toofache32
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Re: Frustrated with dentist fees

Post by toofache32 » Wed Oct 16, 2019 5:23 pm

Jimsad wrote:
Wed Oct 16, 2019 5:16 pm
It is just that other medical specialists , when they contract with insurance as ‘in network ‘ they benefit by getting more patients from that insurance company as they are ‘in Network’
In return , they agree to take the loss if insurance does not pay for a service .
Before everybody jumps all over me , I did not make up the above rules - I am just stating what I have seen from personal experience as I saw EOBS from insurance where they specifically say the provider cannot bill patient for denied services as they are in network (non dental medical doctors )
However , I now acknowledge that dental insurance seems to have different set of rules
The reason to be in-network is to trade more patients for lower fees. The fees are already severely discounted so volume tries to compensate. Work harder for less money. So every loss weighs heavier, not very boglehead. When I was a discount doctor, it was rare to find a scenario where I could not bill for services the insurance denied. When I found them, I simply stopped offering those services.

mariezzz
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Joined: Mon Oct 02, 2017 11:02 pm

Re: Frustrated with dentist fees

Post by mariezzz » Sat Oct 19, 2019 12:41 pm

Jimsad wrote:
Wed Oct 16, 2019 5:16 pm
It is just that other medical specialists , when they contract with insurance as ‘in network ‘ they benefit by getting more patients from that insurance company as they are ‘in Network’
In return , they agree to take the loss if insurance does not pay for a service .
Before everybody jumps all over me , I did not make up the above rules - I am just stating what I have seen from personal experience as I saw EOBS from insurance where they specifically say the provider cannot bill patient for denied services as they are in network (non dental medical doctors )
However , I now acknowledge that dental insurance seems to have different set of rules
You aren't fully informed. A simple google search will reveal many, many reports of people being held responsible for medical costs that they reasonably thought would be covered as 'in network' but weren't. If your medical insurance decides that a procedure is not medically necessary, you will likely be responsible for the whole amount billed, at the rate originally billed - the contract doesn't apply to procedures that are deemed 'not medically necessary'.

For example, if you have a lab test (like a Vitamin D test) that is deemed 'not medically necessary for most people (at least according to BCBS policies instituted in the last 5 years or so), you will be responsible for the original amount (unadjusted by any contractual obligations) billed. Quest Diagnostics charges almost $200 for Vitamin D testing for cash patients; this is about 10x what the insurance company would allow if they considered the test 'medically necessary' for a given patient. If your physician ordered this Vitamin D test for you, and Quest Diagnostics processed the test, and your insurance company did not consider the test medically necessary for you, you'd be responsible for the $200.

With dental insurance, an insurer may decide only amalgam fillings in posterior teeth are covered. If your dentist decides to do a composite filling in those teeth (composite are generally more expensive than amalgam), the insurer may 'allow' only the 'usual and customary rate' for amalgams.

For example, dentist bills $190 for a composite filling in a back tooth, but insurance allows only amalgam in that tooth, and their ''reasonable and customary' fee scale says $150 is the allowable amount for the amalgam. Then, your insurance policies says they cover only 50% of the 'usual and customary' fee. The insurance company pays $75 for the filling. You are then responsible for $115 ($75, which is 50% of the 'reasonable and customary' fee, plus $40 balance billed) for the composite. If you haven't paid your $50 annual deductible, the insurance company will pay only $25, and you will pay $165 (the $50 deductible plus the $75 of the 'allowed' amount, plus $40 balance billed). (This scenario is based on Delta Dental PPO billing practices in my state.)

Some dentists may decide to write off the $40, but the contract may not make that obligatory - it did not in my case.
Other dental policies may have other terms.

For both medical and dental: 'reasonable and customary' fees for a given geographic area can vary across policies, even policies written by the same insurance company. Unless states write laws to reign certain practices in, medical insurance companies have a great deal of leeway in many things.

Based om my experience: Some states oblige dental companies to tell you their 'reasonable and customary' amount for a given dental billing code, others do not. I've lived in both types of states. Since there are a fairly restricted number of likely dental billing scenarios, I've tried to find out the 'reasonable and customary' amounts, and then to find out what the dentist bills for various procedures. In one state, I was able to get the information; in another state, there was no law that obligated the insurance company to tell me this information and they refused to. They claimed that dentists would raise prices if they knew that - which was nonsense, because dentists see what the insurance companies allow when insurance claims are submitted & paid.

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